Please use this identifier to cite or link to this item: http://hdl.handle.net/1959.13/42931

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Title
Safety and effectiveness of high-dose midazolam for severe behavioural disturbance in an emergency department with suspected psychostimulant-affected patients
Author/Creator
Spain, David;  Crilly, Julia;  Whyte, Ian;  Jenner, Linda;  Carr, Vaughan;  Baker, Amanda
Institution
The University of Newcastle. Faculty of Health, School of Medicine and Public Health
Description
Objectives: To trial high-dose midazolam sedation protocol for uncooperative patients with suspected psychostimulant-induced behavioural disorders. End-points were effectiveness and safety. Methods: A prospective pilot study was undertaken with a convenience sample of adult, uncooperative patients with suspected psychostimulant-induced severe behavioural disorders. The protocol was midazolam in 10 mg increments, i.m. or i.v., at 10 min intervals, up to four doses and titrated to an end-point of rousable drowsiness. Results: Sixty-two patients were enrolled. Two-thirds of the patients required only one dose of midazolam; 88% of the sample were sedated with two doses. Six and a half per cent of patients were not sedated after four doses. A Glasgow Coma Score of eight or less was prolonged in eight patients. Airway problems requiring an adjunct were present in four patients. Recent psychostimulant use was present in only 55% after full assessment. Conclusions: High-dose midazolam protocols cannot be supported as universally safe. High-dose protocols for severe behavioural disturbance are not more effective, with failures occurring even after repeated dosing.
Relation
Emergency Medicine Australasia: EMA Vol. 20, Issue 2, p. 112-120
Relation
http://www3.interscience.wiley.com/journal/119425328/abstract
Date
2008
Publisher
Blackwell Publishing
Keyword(s)
emergency;  midazolam;  psychostimulant;  behavioural disturbance
Resource Type
journal article
Identifier
http://hdl.handle.net/1959.13/42931
Identifier
ISSN:1742-6731
Reviewed
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Subject
"Emergency Medicine Australasia: EMA"
 
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